Saturday, January 25, 2020

Communication Skills in Nursing | Reflection

Communication Skills in Nursing | Reflection This essay will present a reflective account of communication skills in practice whist undertaking assessment and history taking of two Intensive Care patients with a similar condition. It will endeavour to explore all aspects of non verbal and verbal communication styles and reflect upon these areas using Gibbs reflective cycle (1988). Scenario A Mrs James, 34, a passenger in a road traffic collision who was not wearing a seatbelt was thrown through the windscreen resulting in multiple facial wounds with extensive facial swelling which required her to be intubated and sedated. She currently has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also involved in the accident. Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high oxygen concentrations. Patients who are admitted to Intensive Care are typically admitted due to serious ill health or trauma that may also have a potential to develop life threatening complications (Udwadia, 2005). These patients are usually unconscious, have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively communicate with patients, colleagues and their close relatives is a fundamental clinical skill in Intensive Care and central to a skilful nursing practice. Communication in Intensive Care is therefore of high importance (Elliot, 1999) to provide information and support to the critically ill patient in order to reduce their anxieties, stresses and preserve self identity, self esteem and reduce social isolation (Joà £o: 2009, Alasad: 2004, Newmarch:2006). Effective communic ation is the key to the collection of patient information, delivering quality of care and ensuring patient safety. Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient clinician relationship, and is increasingly being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial (Carr, 2005). Often the patient is transferred from a ward or department within the hospital where a comprehensive history has been taken with documentation of a full examination; investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes can provide essential information. In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe (Carr, 2005). The Nursing Midwifery Council promotes the importance of keeping clear and accurate records within the Code: Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented. Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for over half of the thoracic injuries from non-penetrating trauma (Middle ton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the risk of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). A key component of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved. Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are expected to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a physical assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role. As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history taking process (Appendix A) and the physical assessment process. Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid asses sment, continuity of care and the reduction of errors. Communication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language touch and eye contact, as technology has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication: Verbal and non verbal. Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Baron:2005, Zastrow:2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate; he was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. Closed questions such as is it painful when you breathe in? or is your breathing feeling worse? can be answered with non ver bal communication such as a shake or nod of the head. Taking a patients history in this way can be time consuming and it is essential that the clinician do not make assumptions on behalf of the patient (Ashworth, 1980). Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al:2000, Alasad:2004). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Alt hough Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles. A patients stay in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be longer lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care delirium. Derlerium can be distressing for both the relatives andthe patient, who may have some recolection after the deleium epsiode (Mclafferty, 2007). Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008). Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore im portant to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been (Baron, 2005). If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process as the Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and diff icult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care. This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad: 2004, Leigh: 2001, MacAuley, 2010: Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be requ ired to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contributions that others offer, to improve patients care and the overall patient experience. Appendix 1, The History Taking Process: The questions are the key to a good interview. You need to use a mix of open ended questions and close ended questions. Open ended questions leave the door open for the patient to tell you more. Questions like when it this problem start?, have you had any recent health problems?, and can you show me where it hurts? are open ended. The patient feels free to provide additional information. While questions like does it hurt here?, did you have this pain yesterday?, and have you had the flu in the past month? are close ended. Close ended questions seek very specific, often yes or no responses from the patient and dont encourage the patient to provide any additional information. Good interviews are a mixture of both kinds of questions. (Secrest, 2009) Basic Elements: 1. Greeting a. Introduction b. Identification of patient and self c. Assessment of the patients overall appearance and demeanor 2. Personal history a. Age b. Occupation c. Sex d. Height / Weight e. Marital / Family status i. Children 3. Chief complaint (CC) or Presenting complaint a. Why is the patient seeking care? b. What other problems concern the patient? 4. History of present illness a. Location and radiation of complaint b. Severity of complaint c. Timing of onset d. Situation (setting) of onset e. Duration of complaint f. Previous similar complaints g. Exacerbating and relieving factors h. Associated symptoms i. Patients explanation of complaint 5. Past medical history a. Systematic questioning regarding previous adult illnesses i. Neurological/Psychiatric ii. Eye, ear, nose, throat iii. Skin/Hair/Nails iv. Musculoskeletal v. Cardiovascular/Respiratory vi. Genital-urinary vii. GI tract b. Childhood illnesses c. Surgeries, injuries or hospital admissions d. OB/GYM i. Birth control ii. Pregnancies / Births iii. Menstrual periods iv. Pelvic exams / Pap smears e. Psychiatric f. Immunizations g. Screening tests h. Allergies 6. Family history a. Disease history b. Parental health c. Childrens health 7. Drug history a. Current medications i. Prescription ii. Over-the-counter b. Drug allergies 8. Lifestyle (social history) a. Alcohol b. Smoking c. Recreational drug use d. Sexual life style/orientation e. Reproductive status f. Occupational issues (Secrest,2009)

Friday, January 17, 2020

Louise Vuitton

Louis Vuitton — one of the oldest fashionable houses of Europe. Its history began in the middle of the XIX century, in 1854. Today, as well as 150 years ago, goods from Louis Vuitton are still made manually. With unmistakably recognizable monogram of â€Å"LV† on the logo, Louis Vuitton it is recognized as one of the most prestigious brands in the world. â€Å"Louis Vuitton is one of the world's leading international fashion houses; it sells its products through standalone boutiques, lease departments in high-end department stores, and through the e-commerce section of its website.Louis Vuitton commonly referred to as Louis Vuitton or shortened to LV, is a French fashion house founded in 1854 by Louis Vuitton. † (louisvuitton, 2011). Environment can be defined as, the amalgamation of external physical circumstances that impinge and influence the augmentation, development and survival of creation. Therefore, the business environment would define as same, all the f actors internal and external that affects its profitability and growth. It is very important for the business leader to carry out business environmental analysis to understand their business topography at present time.To evaluate suitable context of the organisations operations in terms of the internal environment it is best to use SWOT analysis of Louis Vuitton. First of all let is start from strengths. Louise Vuitton is not only one of the oldest, but one of the most legendary houses of fashion in the world. The most valuable argument for the strength of this company is exclusivity. Since the 19th century, manufacture of Louis Vuitton goods has not changed. â€Å"Luggage is still made by hand, utilize the signature brown Damier and Monogan Canvas materials, both of which were first used in late 19th century.† (lvmh, 2012).Also, the company markets it is product though it is own stores located throughout the world, which allows it to control product quality and pricing. â₠¬Å"Louis Vuitton commands a strong brand identity and image in the world’s leading financial hubs such as China, Japan and Hong Kong, which incidentally also has the highest concentrations of high net worth individuals, with loyal customers in Europe and the United States. † (louisvuittonbrand, 2013). Secondly let is identify weaknesses of Louise Vuitton.Limited costumer base is the one of the weaknesses of this company. Only the elite and rich who want to make a statement and want to be distinctive from others can afford Louise Vuitton. Also, it does not have any discount sale on it is products, which means that the company reducing the chances of attracting customers who can afford more economical products. â€Å"LV has not had a sale in 154 years. Louis Vuitton prohibits bargain sales. A core of Louis Vuitton’s pricing strategy is to sell the products to all of its customers at the same price no matter the location.â€Å" (Kraemer, 2012).Thirdly, let is thin k about opportunities. To meet contemporary tastes and styles of it is elite consumers, Louise Vuitton revamping its image from time to time. â€Å"The fashion industry is a pretty dynamic one which changes rapidly over the seasons. Louis Vuitton has the ability to revamp its image from time to time to meet contemporary tastes, styles and preferences of its customers. † (louisvuittonbrand, 2013). Moreover, Louise Vuitton leverages its strong brand equity to product – fashion, accessories, shoes, timepieces, and architecture.And with its continuous innovation and support to different managerial, environmental, and more crucially societal and humanitarian issues and concerns (e. g. corporate sponsorship to support culture, youth and humanitarian action), Louis Vuitton can gain more customer loyalty, which will help give them a greater competitive advantage against rival brands. â€Å"While the brand is one of the leading names in the luxury industry, Louis Vuitton maint ains a strong desire to continue its innovation with high quality raw materials, tamper-proof locks, optimised production processes, and soon a dedicated leather goods hub in Angers, France.† (Quark, 2013).Now let is talk about threats of the company. Louise Vuitton is one of the most counterfeited brands in fashion world due to its image as a status symbol – imitation of quality, expertise and innovation – sued Britney Spears, Darfur Charity infringing LV’s intellectual property rights. Also it is has luxury and strong competitors such as Christian Dior, Chanel, Gucci, Prada etc. And one more thing is animal right group. Campaigners staged a noisy protest outside a Louise Vuitton store on Paris famed Champs Elysees avenue in 2006 for using real fur in decoration and  accessories.â€Å"With the advent of environmental protection and considerations in business, the number of groups protesting against the use of animal skins on fashion and leather goodsâ €  (louisvuittonbrand, 2011). External business environment represent the uncontrollable factors, the external factors can be analysed using PEST analysis. It will cover political, economical, social and technological factors. Political Louis Vuitton has slashed the rate of new store openings to two a year on average, down from 10-15.Its extensive network of 460 shops stretches to Mongolia and Kazakhstan. Higher sales going through fewer stores should boost the profitability of each store. Economical Economical situation, inflation, interest rate and strengths of consumer spending. It will directly affect the Louise Vuitton and its profit, if economical situation is bad consumer will spend less â€Å"Fewer new store openings will also free up cash, which could potentially be returned to shareholders† (Daneshkhu, 2013) SocialLouise Vuitton is wealthiest and renowned member of society Technological The new opportunities to expand on the Internet though online sales and now e ven sales by smartphones â€Å"Today, the Louis Vuitton app includes three document types: PDFs, interactive publications (with video, slideshows, Web sites, specific read modes) and videos. It consists of a kiosk, which is used to navi- gate through the Quark Publishing Platform tree structure to select and download the desired publications before viewing them on the iPad.The app also includes a library for previously downloaded documents (which can be read in off-line mode). † (Quark, 2013) Now this essay will give brief recommendations for Louise Vuitton for the next years. Let is start from short-term recommendations. First of all, to make Louise Vuitton more appealing to the consumer, some products of the brand can be made available only in small quantities, by limiting its production of certain products from time to time, or producing special  edition of the some handbag in different markets, Louise Vuitton could become even more premium.Hence, this can satisfy the co nsumer, who wants to differentiate themselves from other Louise Vuitton users. Louise Vuitton could even create a trend for collection of limited edition Louise Vuitton products. Also, Louise Vuitton can open to franchising with high end malls around the world. Long term recommendations are about to be more distinctive from the competition, Louise Vuitton may consider concentrating its business model to production of leather goods only.If Louise Vuitton could concentrate on leather goods production alone, it could become not just the leader, but also the specialist of producing different leather goods. Also, by offering more economic lines to the consumer, Sub brands will help to fight counterfeiting and broaden their consumer base In conculion, as Louis Vuitton continues to build on its strong history, add to its portfolio, and show continued growth, now is a strategic time to invest as stock and value continue to rise.â€Å"The company’s maturity and proven stability make it attractive and investors can rest assured that there would be a low level of volatility in their investment. †(Nebia, 2012) Investors can also be comfortable with the fact that this is not exactly a â€Å"widows and orphans† stock, Louise Vuitton has had continuous expansions by acquiring other well know luxury goods companies and continues to make substantial investments. This has helped to further differentiate sources of revenue and gain more consumers. The company’s innovation in the sector and well-established culture make it standout investment.

Thursday, January 9, 2020

Classical Conditioning And Its Effects On The Environment

Classical Conditioning focuses on stimuli in the environment, such as noise, light, shock, and taste of food, that automatically evoke reflex responses. These stimuli are known as unconditioned stimuli, while the responses they elicit are known as respondents, which are often involuntary or automatic seeing as the individual has no control over them. An example of a respondent would be an individual exhibiting a startle reaction in response to a loud noise. A conditioned stimulus, or a neutral stimulus, can become associated with an unconditioned stimulus that evokes the response and if the two are presented simultaneously, the conditioned stimulus alone will eventually evoke the response. In classical conditioning, a new stimulus gains the ability to evoke a respondent behavior within the individual (Craighead, Criaghead, Kazdin, Mahoney, 1994). Aversion Therapy is an example classical conditioning. 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